Ask the Midwife – Zika Virus

Q: I planned a trip to a beachside resort in Mexico a few months ago and just now found out that I am pregnant.  My mom said it isn’t safe for me to go because of Zika virus, but I already paid for the trip. What should I do?

A: Congratulations on your pregnancy!  Our primary goal is for you to have a healthy pregnancy as well as a safe and happy outcome for you and your baby.  Zika virus is a serious concern in pregnancy.   This disease is spread by the bite of 2 types infected mosquitoes, as well as through sexual contact.  The virus can cause severe birth defects of the brain in the developing fetus, as well as miscarriage, stillbirth and a disease of the nervous system called Guillain-Barre syndrome.  Unfortunately at this time, there is no vaccination against Zika.  The CDC recommends that all pregnant women avoid travel to areas of the world where Zika is being transmitted.  If travel is unavoidable, steps must be taken to minimize the risk of being infected with the virus.  If you travel to an area that is known for Zika transmission, your provider will arrange for testing for the virus one or more times during your pregnancy, and will advise you to refrain from sexual intercourse during your pregnancy.

Areas of the world that are known to present a risk of Zika virus transmission include: Mexico; the Caribbean (including but not limited to the Virgin Islands, Puerto Rico, Cuba, Jamaica and the Bahamas); all Central American countries; most South American countries; much of Africa; parts of Asia including India, the Philippines, Vietnam and Burma; and some of the Pacific Islands.  Additionally, the areas of Miami-Dade county and Brownsville, Texas have reported mosquito-borne Zika infections.  The CDC has a current list of all countries affected.

The CDC recommends that people who travel to places where Zika is found take steps to avoid mosquito bites.  This includes staying indoors, using screens on windows and doors, sleeping under mosquito nets, and using insect repellents on the skin.  Recommended repellents include those containing DEET, Picaridin, IR3535, oil of eucalyptus and 2-undecanone.  EPA registered repellents are preferred.

Zika can be passed through vaginal, anal and oral sex. The virus can remain for prolonged periods in semen, which is the reason for the recommendation to avoid sexual intercourse during pregnancy if there has been a risk of exposure. The virus can be found in semen for as long as 6 months.  If intercourse occurs, condoms should be used every time, from beginning to end, and dental dams should be used for oral sex.  It is safest to not have sex for the entire pregnancy.  If only the male partner of the pregnant woman is visiting a Zika affected area, condoms should be used for 6 months or they should abstain from intercourse. If symptoms develop in the male partner, contact a healthcare provider for instructions on testing.

Many people who are infected with Zika will have no symptoms at all, or very mild symptoms that could last a few days to a week.  Zika symptoms can include fever, muscle pain, rash, red eyes, headache or joint pain.   Zika can have symptoms that are similar to other tropical illnesses such as Dengue Fever and Chikungunya so it is important to receive the correct testing.  Your provider will work closely with the NM Public Health Department to plan the timing and type of tests.   There is no medication for Zika but symptoms can be treated with rest, fluids and Tylenol. It is not recommended to take aspirin or ibuprofen.

Finally, I know it is disappointing to have to change plans, but I would recommend that you not take your trip to the beach in Mexico, and perhaps go somewhere  that there is no risk of Zika, such as  a mountainous area of Mexico, at an elevation over 6,500 feet (no mosquitoes up there) or an alternative location, such as France or Italy.  While traveling to the high elevation, precautions against mosquitoes need to be taken if in lower elevations in transit.  Finally, only you and your partner can make the decision on whether to take the risks, but the potential for severe problems in the fetus is a real concern, and one that should be taken very seriously.  For further information on Zika and pregnancy, please reference the CDC Travel PDF.  We hope you have a happy and healthy pregnancy!